Resuscitation apparatus



W. BRANOWER RESUSCITATION APPARATUS June 13, 1939.

Filed April 25, 1956 2 Sheets-Sheet l I A4 INVENTOR W W ATTORN EY June13, 1939.- B RANOWER' RESUSJQITA'IAION APPARATUS Filed April 25, 1936 2Sheets-Sheet 2 INVENJ'OR ATTORNEY Patented June 13, 1 939 1.. UNlTEDSTATES PATENT OFFlCEf RESUSCITATION APPARATUS William Branower, NewYork, N. Y.

Application April 25, 1936, Serial No. 76,369

5 Claims.

This invention relates to resuscitation appation is to provide improvedapparatus for artiratus.

vived by theapplication of heat and stimulants,

and the inhalation of oxygen or a low mixture of carbon-dioxide andoxygen.

In other cases where there is a temporary suspension of animation andmore or less paralysis of the respiratory and cardiac centers, thevitality of the nervous system is not completely abolished and thepatient can be revived with ordinary methods of artificial respirationor apparatus for that purpose.

In very severe cases of asphyxia it is often impossible to revive thepatient by the ordinary methods and apparatus employed for artificialrespiration. In these extreme cases of asphyxia, with respirations at astandstill and the vital centers of the medulla almost completelyparalyzed,'insufilation of small volumes of oxygen under low pressuredoes not suffice to inaugurate that chain of stimuli which motivates therespiratory mechanism.

Under normal conditions, there is a respiratory exchange in the averageadult of approximately fivehundred cubic centimeters of air during eachquietrespiration. 'This'volume is known as the tidal volume. For largeadults the average tidal volume is six hundred cubic centimeters, andfor children very much less, the amount depending upon the age of thechild. The postural methods of artificial respiration, of which theSchaefer prone pressure technique is the most popular, can not effect arespiratory exchange of much more than one-half the tidal volume of theaverage adult, and. this may be ineffective to inaugurate the chain ofstimuli necessary to revive the victim. Apparatus capable of supplyinglarger volumes has been devised, but as far as I am aware my inventionis the first combination of apparatus with which the tidal volume, ordefinite, prescribed multiples of the tidal volume, can be administeredwith perfect control, by the operator, of the rhythm, volume andintrapulmonary pressure.

It may be said that one object of the invenficial respiration withmeasured and controlled volumes and lung pressures.

Another object is to provide a simple and convenient apparatus forrevival by artificial 'resand this rate is indicated on a gauge whichhas a scale with notations along its length desi'g nating the age orsize of the patient for which various points on the scale represent thecorrect tidal volume per second. The flow control device can, therefore,be adjusted'until the gauge indicator registers with the notationcorresponding to the age or size of the patient to'be treated,

and the apparatus is then operated to administer the tidal volume or aprescribed multiple of" the tidal volume for that patient by making'the5;

period of inspiration one, two or three seconds; Another object of theinvention is to provide an improved portable resuscitation apparatus,which issimple, compact, and convenient to'use for giving varioustreatments which maybe required by victims of asphyxia. Other objects,features and advantages ofthe invention will appear or be pointed out asthe specification proceeds.

In the accompanying drawings, forming part hereof: Fig. 1 is a sideelevation of the preferred embodiment of my improved apparatus forartificial respiration; 1

Fig. 1 is a side elevation of a catheter, which i may be attached to theapparatus of Fig.1 in place of the face mask; v Fig. 2 is a top planview of the'apparatus of Fig. 1 with the bag, tube, and face maskremoved; Y

Fig. 3 is an enlarged side elevation ofthe respiratory valve, and asectional view of the valve at the bag entrance. the sectionbeing takenon the line 3-3 of Fig; 1 but with'the valves in different positions; aFig. 4 is an enlarged sectional view on the-line 4-4 ofFig. 2; and lFigs. 5-8 are diagrammatic sectional views of the respiratory valve indifferent positions. A manifold H is supported by a standard 12connected to and extending upward from a base I3. Casters M on the baseadd to the portability of the apparatus. The standard I2 is adjustablein height and comprises a hollow column [6 which telescopes into a lowercolumn I! but can be held in any set position by a set-screw l8. Themanifold H has a stem that fits into the upper end of the hollow columnl6 and is secured in place by a set-screw 20.

The manifold II has three branches for connecting with gas storagecylinders. One cylinder 22 is shown connected to the manifold I! by asupporting clamp 23 at the end of one branch of the manifold. Similarclamps at the ends of the other manifold branches are shown in Fig. 2and the positions which the other cylinders would occupy are indicatedby broken-line circles 25.

Of the three cylinders which can be connected to the manifold, one maycontain oxygen, another a low-percentage mixture of carbon dioxide andoxygen, and the third a higher-percentage mixture of carbon dioxide andoxygen or other therapeutic gases. When necessary to connect themanifold with commercial size cylinders or other sizes which do not fitinto the clamps 23, "pigtaiP tubing is used and by such means themanifold can be connected with any size of cylinder.

Each branch of the manifold has a shut-off valve 21, which can be closedto permit the removal and replacement of a cylinder without stopping orotherwise interfering with the operation of the apparatus forresuscitation.

A pressure gauge 29 at the center of the manifold ll indicates the gaspressure in the manifold. When one cylinder is in communication with themanifold, the gauge 29 shows the pressure and indicates the availablesupply of gas in that cylinder. r

The manifold ll supplies gas to a regulator and flow control device 30which reduces the pressure and delivers definite volumes of gas per unitof time. The flow control device 36 preferably includes a two-stageregulator like that disclosed in the Deming Patent No. 1,948,027, datedFebruary 20, 1934, and an orifice on the downstream side of theregulator. This orifice is of a restricted cross-section so that for thehigher rates of flow that the control device 36 is intended to deliver,the intrapulmonary pressure is substantially lower than the criticalpressure at which flow through the orifice would be affected by backpressure. In the description of this invention volume of gas meansvolume reduced to a standard of temperature and pressure. This standardis preferably 70 F. and normal atmospheric pressure. A flow controldevice using an orifice to supply a constant weight of gas willtherefore supply a constant volume. The flow control device has a handle3! by which it can be adjusted to change the rate of delivery.

The volume of gas delivered per second by the flow control device 3|] isindicated by a gauge 33. This gauge has an indicator 34 which travelsaround a scale 35. There are notations along the scale designating thetidal volume of gas for patients according to age or size. For example.the average tidal volume of a 5 year old child is 110 cubic centimeters,and the 110 cubic centimeter point on the scale 35 has the notation 5yrs. so that when using the apparatus to resuscitate a child of that agethe operator can turn the handle 3! until the indicator 34 rises to the5 yrs. notation. The apparatus will then deliver the tidal volume forthe child in one second.

The length of time that gas flows from the flow control device 36 to thepatient is regulated by a respiratory valve 36 having a handle 3'! witha pointer 38 which travels over a dial 39 on the front of the valve.Markings on the dial show the positions of the respiratory valve forinspiration, expiration, and inhalation, the markings for these valvepositions being designated by the abbreviations Ins, Exp, and Inh.,respectively.

The respiratory valve 36 has a port and conduit 4|, through which itreceives gas from the flow control device an. In case of failure of thecompressed gas supply, air can be fed into the conduit 4| from abellows, air compressor, or other source connected with an air inlet 42.This inlet is closed by a stopcock 43 during the ordinary operation ofthe apparatus.

The respiratory valve 36 has a port and conduit 45, from which gas issupplied to the patient through a T fitting 46, elbow 41, conduit ordelivery tube 48, adapter 49, and face mask 50.

Instead of the face mask 5!], an intratracheal tube or a pharyngealairway 52, shown in Fig. 1 can be connected to the adapter 49 by meansof an end coupling 53. The tube 48 is preferably short, to eliminatedead space, and is flexible, non-collapsible and of large lumen, topermit to and fro breathing without resistance.

1 Through a port and conduit the respiratory valve 36 communicates withthe upper end of a valve casing 56, the lower end of which opens into abag 51. There is a port 58 in the side of this valve casing 56, and avalve element operated by a handle 59 opens and closes this port and atthe same time closes and opens passages leading to the bag 51.

Fig. 3 shows the construction inside of the valve casing 56. A partition6! extends across the inside of the valve casing 56. There are openings62 in this partition for the passage of gas. A valve element 63 havingthe form of a cylindrical cup has openings through its bottom walladapted. to register with the openings 62 when the valve element is inone position. The angular spacing of the openings in the bottom of valveelement 63 and in the partition 6| is so related to the size of theopenings that rotation of the valve element causes all of the openingsto be blocked. as

when the shaker top of an ordinary powder can is closed.

There is a port in the side of the valve element 63 which registers withthe port 58 when the valve element is in one position. The side port inthe valve element 63 is in such relation with 5:

the bottom openings, however, that the valve element closes the port 58when the openings in the bottom of the valve element are in registerwith the openings 63 through the partition. Movement of the handle 59far enough to completely open the port 58 shifts the valve element 63into position to fully close the openings 62.

The handle 59 can be moved, therefore, into one position to put theconduit 55 into communication with the open air through the port 58while the passages to the bag 57 are completely closed, or the handle 59can be moved into another position in which the conduit 55 is incommunication with the bag 51 and the port 58 fully closed. Intermediatepositions of the handle 59 leave the port 58 and openings 62 both openin varying degrees.

The valve element 63 is held in light frictional contact with thepartition 6| by a spring 65 which is compressed against the valveelement 63 by a screw 66.

The respiratory valve 36 contains a valve element 68 having right-anglepassages which can be moved into register with the valve ports toconnect any combination of the conduits 4|, 45 and 55. Fig. 5 shows thevalve element 68 in the Inspiration position. Gas from the flow con-]trol device, orother source, flows to the conduit 4| and straightthrough the valve 36 to the con.- -duit 45. With the valve element 68 inthis position gas is supplied from the storage cylinder to the patientat a rate determined by the adjustin the position shown in Fig. 5 forone second.

If the child is to be given twice or three times his tidal volume, theoperator leaves the valve element 68 in the inspiration position for twoor three seconds, respectively.

At the end of one, two or three seconds, the valve element 68 is turnedto the expiration position shown in Fig. 6. With the valve. element inthis position the conduit 4! is closed and the conduits 45 and 55 are incommunication. The patient exhales through the valve 36 and into thevalve casing 56, from which the expired gas escapes into the open airthrough the port 58. This port is kept open when the apparatus is beingused for artificial respiration. The bag 51 is used only when thepatient is breathing naturally but it is desirable to administer sometherapeutic gas from the bag.

It should be noted that the apparatus employs no suction to deflate thelungs. Any suction to facilitate expiration is unnecessary, evendangerous, and is intentionally dispensed with. The natural highelasticity and resiliency of the lungs effect an immediate recoil to thecollapse-d state when the pressure or inflating force is removed at theend of the inspirato-ry phase. Suction closes and obliterates thethin-walled bronchioles before it succeeds in emptying the alveoli oftheir noxious or poisonous gases, and thereby defeats the very purposefor which artificial respiration is intended.

If the valve element 68 is stopped in a Neutral position, in which itspassages do not register with any of the valve ports, as is the case inFig. 7, then the respiratory valve cuts off the supply of gas to thepatient and at the same time prevents escape of the insufllated gasesfrom the lungs. The valve element 68 is ordinarily moved back and forthbetween the inspiration and expiration positions of Figs. 5 and 6without stopping in the neutral position shown in Fig. '7. The specialcircumstances in which the neutral position of the valve element is usedwill be explained in connection with the description of thedetermination of intrapulmcnary pressure.

Fig. 8 shows the valve element 68 in its Inhalation position. Thisposition is used only when the patient is breathing naturally but it isdesirable to administer some therapeutic gas. The handle 59 can beshifted to various positions to cause the patient to breathe into andout of the bag, or only partly from the bag if the port 58 is partiallyopen.

An arm 'HJ (Fig, 1) extending from the stem of the handle 3'5 strikesagainst limit abutments H and 12 when the pointer 38 reaches theinspiration and inhalation notations; Aleaf'spring I3 is fastened to theback of the dial 39 and has aportion extending through an opening in thedial in positionto stop the arm 10 when the valve 36 reaches itsexpiration position. When theapparatus is being used for artificialrespiration, the handle 31 is turned back and forth between the limitsimposed by the abutment H and the limit stop provided by the forwardlyextending portion of the leaf spring 13.

The spring 13. has an end portion extending beyond the edge of the dial38 so that the spring can be pushed back out of the way of the arm 10when the valve 36 is to be moved into its inhalation position. The arm10 strikes the abutment 12 when the pointer 38 reaches the inhalationnotation on the dial.

A- manometer 15 communicates with the interior of the fitting 46 througha stopcock 16, which is always open when the apparatus is in use. Thismanometer indicates the intrapulmonary pressure at all times, and thecolumn of the manometer moves up and down with the inspirations andexpirations of the patient. If the exact pressure at some particulartime in the cycle is desired, the respiratory valve 36 can be turnedinto its neutral position to stop the 0scillating movement of themanometer column.

An expiratory valve H in the elbow 41 is a spring-loaded relief valve,and the tension on the spring can be relaxed by means of an adjustingscrew 18 to permit the escape, through ports 19,01 some of the airexhaled by the patient. This valve 11 is heavily loaded and does notfunction when the apparatus is used for artifical respiration, but withthe patient breathing naturally, and the valve 36 in inhalationposition, the expiratory valve 11 is adjusted to determine the extent ofrebreathing by permitting various amounts of exhaled air to escape intothe atmosphere.

When the apparatus is employed for artificial respiration it isessential that precaution be taken against excessive intrapulmonarypressure. A safety valve 8| comprises a tube 82 which communicates withthe interior of the fitting 46 through a stopcock 83. The stopcock. 83is intended to be open at all times and its only purpose is to prevent aleak in the apparatus in case the safety valve 8| becomes broken. Thestopcock 83 is tight so that it is difiicult to turn. This preventsaccidental closing, which would make the safety valve 8| ineffective.

The tube 82 extends into a vessel 84 which is partially filled withliquid, preferably mercury. The vessel 84 is connected to a cover 85,which is perforated to permit gas to escape from the vessel. The tube 82extends through an opening in the cover 85, and the cover can be movedup and down along the tube to determine the depth of immersion of thetube 82 in the mercury. A setscrew 86 threads through the hub of thecover 85 and clamps against the tube 82. There is a scale 81 on theupper portion of the tube 82, and this scale has notations whichindicate the pressure at which gas will escape from the tube 82 andthrough the mercury in the vessel 84 when the top surface of the hub ofthe cover 85 is even with the various markings on the scale 8'1.

A second safety valve 88 is connected with the branch of the T fitting46. The internal construction of the safety valve 89 is shown in Fig. 4.it valve element 9|] closes the end of an inlet conduit 9|. The valveelement 90 is in a chamber which is closed. at the top by a diaphragm92, and this chamber has an exhaust conduit 93 communicating with theopen air. The diaphragm 92 and valve element are urged downward by aspring 94 enclosed in a cylindrical housing 95. A plug 96 fits threadson the inside wall of the housing 95, and can be screwed up or down inthe housing to change the tension of the spring 94 which determines thepressure at which the safety valve operates.

The plug 96 is connected to a sleeve 91 which fits over the outside ofthe housing 85. As the sleeve 91 is rotated to screw the plug 96 furtherdown in the housing 95, the sleeve moves downward with the plug and thebottom edge of the sleeve moves over a scale on the outside of thehousing 95. Notations on the scale indicate the pressure at which thesafety valve 89 will open when the bottom edge of the sleeve is evenwith the respective markings of the scale. The safety valve can be heldin any set position by a setscrew 98, which threads through the sleeve91 and clamps against the housing 95.

Referring again to Fig. 1, a vacuum pump I00 attached to the base I3 isoperated to withdraw air from a receptacle IOI which communicates withthe suction side of the pump through a fitting I03 and hose I04. Thefitting I03 clamps on the pump cylinder and serves as the support forthe receptacle. A tube I06 communicates with the interior of thereceptacle through a fitting I01.

When the pump I00 is operated to produce a partial vacuum in thereceptacle IOI, the tube I06 can be inserted into the oral andrespiratory passages of the patient to clear these passages by suckingblood or other obstructing fluid or semi-fluid material into thereceptacle. Such a clearing of the patients air passages may benecessary before artificial respiration is begun and may be required atintervals during the resuscitation process if the passages tend to fillup.

The preferred embodiment of the invention has been described, butchanges and modifications can be made and some features may be usedwithout others without departing from the inention as defined in theclaims.

I claim:

1. Resuscitation apparatus for delivering measured and controlledvolumes of therapeutic gases to a patient, including in combination adevice for connection with a gas storage cylinder or other source of gasunder pressure, a gas flow control device which receives the gas at highpressure and delivers it at a reduced pressure and at a rate of flowlimited to a given volume of gas per unit of time, said control deviceincluding means for changing its rate of delivery, a gauge havingnotations of the tidal volume for the lungs of patients according to ageor size, said gauge including means for indicating the delivery rate ofthe control device with reference to the notations on the dial, aconduit through which gas from the control device is delivered to apatient, and a valve between the control device and said conduit, saidvalve being effective in one position to establish communication betweenthe control device and conduit so that gas flows to the patient, andeffective in another position to shut off the gas supply to the patientand open the conduit to the atmosphere to permit the patient to exhale.

2. Apparatus for artificial respiration including in combination meansfor connection with a source of gas under pressure, a gas flow controldevice for receiving the gas under pressure and delivering it at areduced pressure and predetermined uniform rate, means for supplying thegas to a patient including a conduit, a respiratory valve between theconduit and the delivery side of the flow control device and effectivein one position to put the conduit in communication with the deliveryside of the flow control device and effective in another position toopen the conduit to an exhaust port, a gauge on said conduit forindicating the intrapulmonary pressure at all times, and another gaugebetween the flow control device and respiratory valve for indicating thevolume of gas supplied to the patient in a unit of time.

3. Resuscitation apparatus comprising a gas flow control device whichlimits to a predetermined value the rate of flow and pressure of gassupplied from a high-pressure source, means for administering gas to apatient including a conduit, an inflatable bag, a respiratory valvehaving three ports through which the valve communicates with the flowcontrol device, conduit, and bag, respectively, said respiratory valveincluding a valve element which can be moved into four positionsincluding an inspiration position in which it connects the flow controldevice with said conduit and closes the port communicating with the bag,a neutral position in which it closes all ports, an expiration positionin which it connects the conduit and the port leading to the bag andcloses the flow control device port, and an inhalation position in whichit connects all ports, and another valve between the respiratory valveand the bag operative to put the bag-communicating port of therespiratory valve in communication with either the bag or the outsideair.

4. Resuscitation apparatus comprising a gas flow control device whichlimits to a predetermined value the rate of flow and pressure of gassupplied from a high-pressure source, means for administering gas to apatient including a conduit, an inflatable bag, a respiratory valveoperative to establish communication between the flow control device,conduit, and bag in any combination or to shut off all communicationbetween the flow control device, conduit, and bag, another valve betweenthe respiratory valve and the bag operative to connect the respiratoryvalve with either the bag or the outside air, an expiratory valve on theconduit adjustable to permit the escape of some gas from the conduit andthereby regulate the extent of rebreathing when the respiratory valve isin position to cause the patient to breathe into the bag, a gauge forindicating the rate of flow of gas from the flow control device, andanother gauge, communicating directly with said conduit, for indicatingthe intrapulmonary pressure regardless of the position of therespiratory valve.

5. Resuscitation apparatus including in combination a manifold forconnection with a plurality of gas storage cylinders, a pressure gaugeon the manifold, a flow control device connected with the manifold, andconstructed and arranged to limit the rate of flow of gas to a definitevolume per unit of time, a gauge associated with the flow control deviceand adapted to indicate the rate of flow from said control device, meansfor administering gas to a patient including a conduit, an inflatablebag, a respiratory valve operative to establish communication betweenthe flow control device, conduit, and bag in any combination or to shutoff all communication between the flow control device, conduit, and bag,

another vaIve between the respiratory valve and the bag operative toconnect the respiratory valve with either the bag or the outside air, anair-inlet valve through which air can be supplied to the respiratoryvalve through its connection to the flow control device in the event ofexhaustion of the gas in the storage cylinders on the manifold, a, gaugecommunicating directly with the conduit and indicating theintrapulmonary pressure regardless of the position of the respiratoryvalve, and relief valve means connected with the conduit for limitingthe intrapulmonary pressure to a predetermined maximum,

WILLIAM BRANOWER.

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